1609917897 NPI number — MRS. MARILYN RODRIGUEZ M.S.

Table of content: MRS. MARILYN RODRIGUEZ M.S. (NPI 1609917897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609917897 NPI number — MRS. MARILYN RODRIGUEZ M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ
Provider First Name:
MARILYN
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609917897
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 645 BOX 6387
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRUJILLO ALTO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00976-9746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-292-0205
Provider Business Mailing Address Fax Number:
787-292-0205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 AVE CUPEY GDNS
Provider Second Line Business Practice Location Address:
PLAZA CUPEY GARDEN, SECTOR #3
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00926-7341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-292-0205
Provider Business Practice Location Address Fax Number:
787-292-0205
Provider Enumeration Date:
02/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  1693 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1713 . This is a "PSYCHOLOGIST" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2403 . This is a "PSYCHOLOGIST" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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